Current insights and future directions in Peyronie's disease management: A narrative review

Abstract

Peyronie's disease (PD) is an inflammatory and fibrotic disease which results in disfiguring and often distressing penile curvature deformity, affecting up to one in nine men in the United States, and between 0.3% and 13.1% of men globally. It progresses through an acute phase, associated with pain, as the fibrosis develops. In the quiescent phase, penile pain ceases and deformity stabilizes. The precise etiology remains unknown despite ongoing work to elucidate the biological underpinning. The diagnosis is guided by history and physical examination. Except for ultrasonography, imaging is not routinely recommended. Current management is predicated on symptomatic control and slowing progression in the acute phase, and correction of bothersome curvature in the stable phase. Most nonsurgical treatment options are poorly supported by available evidence, with the exceptions of traction therapy and certain intralesional injections. Surgical treatment, considered only after stabilization, is guided by severity and the presence or absence of erectile function and is highly individualized. Investigations are ongoing into several areas, including the exact biological mechanisms leading to plaque formation and failure of resolution; the effects of co-existing systemic disease; the role of imaging in diagnosis and surgical planning; combination and regenerative nonsurgical therapies; and improvements in surgical techniques. As diagnostic accuracy improves and targeted treatments become available, management of PD will become progressively tailored to an individual's particular disease. In this review, we summarize the current knowledge regarding PD, including etiology and epidemiology, diagnosis, management, cutting-edge research, and future directions in care of this condition.

Keywords

injection / penile prosthesis / Peyronie's disease / plication / regenerative medicine / traction / tunical lengthening

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